NURSING

PROCESS
CLASS

MALI MARY HRANGKHAWL

Critical Thinking
Definitions

Critical Thinking is “reflective and reasonable thinking that is focused

on deciding what to believe or do “. Paul (1992)

Critical Thinking is “ the art of thinking about your thinking while you
are thinking in order to make your thinking better: More clear , more
accurate, or more defensible”. Rubenfeld and Scheffer (1995)

Critical thinking is a “ blend of vie modes of thinking : Total Recall ,

Habits , Inquiry , New Ideas and Creativity , and Knowing How You
Think”.
Importance of Critical Thinking
Critical thinking helps the nurse find options for solving client care
problems .
Client and family develop thinking skills fro their own use at the
home .
Critical thinking helps the nurses to choose solutions in the different
client care situations or identify options from which to choose.
The critical thinking is used for effective , creative and efficient
nursing care because of growing complexity of health care demands
Phases of Critical Thinking
1. Trigger event .A 2. Appraisal of the
problem that is situation Self –
reframed as an examination of one’s
opportunity for underlying
improvement assumptions

Phases
of CT
3. Exploration – 4. Integration –
Searching for new ideas , Incorporation new
solutions and / or information and new
approaches ways of thinking
Competencies ,Attitudes for Critical
Thinking
Critical thinking includes attitudes as well as cognitive
skills. Richard Paul (1990) referred critical thinking as
“Traits of mind” .They motivate /encourage and justify the
use of cognitive skills .A critical thinking make the use of
effective attitudes while thinking about what to believe or
how to perform.
 Active Attitude

Intellectual
sense of justice

Intellectual Intellectu
Humility Intellectual
al Perseveran
Intellectual Empathy ce
Courage
Faith in
Reason

Intellectual
Integrity
Cognitive Thinking Skill
Cognitive thinking skill is the ability to think of judge
cognitive components of critical thinking as follows:

1. Divergent thinking : it is the ability of client to

analyze a variety of opinions and judgments .While
assuring the health status of client , a critical thinking
nurse will gather information from client , his family
members , medical wards [Link] she will analyze it
critically to draw conclusion i.e identify the actual
problem.
[Link] : in simple words reasoning means “ what is
the logic behind. It is the ability to differentiate between
true and false quesses or belief. Reasoning is of two types:
 Types of
Reasoning

Inductive thinking : Deductive thinking :

Involves generalization Making decision based
e.g As a teachers you upon no. of
observed that your observations /proofs .E.g
student seems very all postoperative clients
tensed before are at risk to develop
examination .With infection .Nurse may
inductive thinking , you assume that her client
conclude that students undergone for knee
before exam , experience replacement is at risk for
anxiety . developing infection.
3. Reflection : it is the ability of critical thinker to
integrate new ideas or insights at any time. This new idea
may be taken from past experiences , new learning , recent
research studies.
4. Creativity : it is the ability to produce / develop new
ideas and alternatives. Creativity involves use of intuitive
inferences .
[Link] : it is the skill to identify the similarities ,
differences and deriving conclusions for clarifying
anything , nurse must have knowledge of that topic
[Link] Support : basic support involves making and
judging our observations and the credibility of our sources
of information.
Nursing Process
It is a problem – solving method .It
means a series of planned steps
and actions directed to meet the
needs of the patient .The nursing
process is systematic , goal –
directed , flexible and rational
approach.
Characteristics of the Nursing Process
1. The nursing process is a cyclical and ongoing process that can
end at any stage if the problem is solved .
2. The nursing process exists for every problem that the patient
has, and for every element of patient care , rather that once
for each patient .
3. The nurse’s evaluation of care will lead to changes in the
implementation of the care and the patient’s needs are likely
to change during their stay in hospital as their health either
improves or deteriorates
4. the nursing process not only focuses on ways to improve the
patient’s physical needs , but on social and emotional needs
as well.
Advantages of Nursing Process
1. Helps to create a health data base of a patient
2. Helps to identify actual or potential health problems of a patient .
3. Helps to establish priorities of nursing actions for providing proper
services to the patients
4. Helps to define specific nursing actions for providing proper services
to the patients
5. Helps to develop planned , organized and individualized nursing care
6. Help to encourage for innovative nursing care
7. Helps to provide for alternative nursing actions
8. Helps to develop nursing autonomy and foster nursing accountability
9. Helps to increase the effectiveness for nursing care
10. Ensures consistent , continuous and quality nursing care
The Steps of the Nursing Process
The steps of the nursing process are cyclic , overlapping
and interrelated
1. Assessment
2. Diagnosis
3. Planning the patient – central
focus of care
4. Implementation
5. Evaluation
ASSESSMENT
Definition : - It is systematic and continuous collection ,
validation and communication of client data as compared
to what is standard /norm.
PURPOSE : -to establish a database ( all the information
about the client )
1. Nursing health history
2. Physical assessment
3. The physician’s history & physical examination
4. Results of laboratory & diagnostics tests material from
other health personnel
TYPES OF ASSESSMENT
1. Initial assessment – assessment performed within a
specified time on admission (example : nursing
admission assessment )
2. Problem – focused assessment – used to determine
status of a specific problem identified in an earlier
identified in an earlier assessment. ( example : problem
on urination – assess fluid intake & urine output hourly)
 continue
3. Emergency assessment – rapid assessment done
during any physical / physiologic crisis of the client to
identify life threatening problems.( example : assessment of
client’s airway , breathing status & circulation after a cardiac
arrest)
4. Time – lapsed assessment – reassessment of client’s
functional health pattern done several months after initial
assessment to compare the client’s current status to
baseline data previously obtained
ACTIVITIES / PHASE OF ASSESSMENT
1. Collection of data
2. Validation of data
3. Organization of data
4. Analyzing of data
5. Recording / documentation of data
1. Collection of data
a. It is about gathering of information about the client
b. It includes physical ,psychological ,emotional , socio-
cultural, spiritual factors that may affect clients’ health
status
c. It includes past health history of client (allergies , past
surgeries , chronic diseases , use to folk healing methods)
d. It includes current/ present problems of client (pain ,
nausea , sleep pattern , religious practices , medicine or
treatment the client is taking now )
Types of data
Subjective data
a. It is also referred to as symptom /covert data
b. Information from the client’s point of view or as described
by the person experiencing it
c. Information supplied by family members and other health
professionals are considered SUBJECTIVE DATA
Types of data
Objective data
a. It is also referred to as sign/overt data
b. Those can be detected , observed or measure / tested
using accepted standard or norm
Example : pallor , diaphoresis , BP = 150 / 100 mmhg ,
yellow discoloration of skin
Methods of Data Collection
1. Interview : a planned , purposeful conversation
/communication with the client to get information , identify
problems , evaluate change , to teach , or provide support
or counseling
2. Observation : it is used to gather data by using the 5
SENSES and instruments. Observation is a deliberate skill
[Link] : systematic data collection to detect
health problems using unit of measurements, physical
examination techniques (IPPA) , interpretation of laboratory
results
Examination
It should be conducted systematically :
a. Cephalocaudal approach – head –to- toe assessment
b. Body system approach – examine all the body system
c. Review of system approach – examine only particular
area affected
Source of data
1. Primary data – data directly gathered from the client
using interview and physical examination
2. Secondary source – data gathered from client’s family
members, significant others , client’s medical record s/
chart , other members of health team , and related care
literature / journals
Guidelines for data collection
In the initial assessment
phase, assessment data are
gathered through the health
history and the physical
assessment
Components of a Nursing Health
History
1. Biographic data – Name , address, age ,sex , marital
status , occupation , religion
2. Reasons for visit/ chief complaint – primary reason
why client seeks consultation or hospitalization
3. History of present illness – includes : usual health
status , chronological story , family history , disability
assessment
4. Past health history – includes all previous
immunizations, experiences with illness
5. Family history – reveals risk factors for certain diseases
(DM ,HTN , cancer , mental illness )
6. Review of systems – review of all health problems by
body systems
[Link] style – includes personal habits like diet , sleep , rest
pattern , activities of daily living , recreation of hobbies
[Link] data – include family relationships, ethnic and
educational background conditions
9. Psychological data – information of patients
[Link] of health care – includes all health care
resources: hospital s, clinics, health centers , family doctors
Physical assessment
A physical assessment may be
carried out before, during or after the
health history depending on the
patient’s physical and emotional state
and the immediate priorities of the
situation
It includes systemic collection of
information about the body systems
continue
 A body system format for physical assessment is found below:
 1. General assessment 11. Reproductive system
 2. Integumentary system 12. Musculoskeletal system
 3. Head, ears, eyes , nose ,throat
 4. Breast and axillae
 5. Thorax and lungs
 6. Cardiovascular system
 7. Nervous system
 8. Abdomen and GI system
 9. Anus and rectum
 10 . Genitourinary system
2. VALIDATION OF DATA
The act of double – checking or verifying data to confirm
that it is accurate and complete
PURPOSE OF VALIDAITON
1. To ensure that data are collected is complete
2. To ensure that objective and subjective data agree
3. To obtain additional data that may have been overlooked
4. To avoid jumping to conclusion
5. To differentiate cues and inferences
Cues : subjective or objective data observed by the nurse:
it is what the client says , or what the nurse can see ,
hear , feel , smell or measure
Inferences : the nurse’s interpretation or conclusion based
on the cues example
Red swollen wound = infected wound
Dry skin = dehydrated
3. ORGANIZATION OF DATA
Uses a written or computerized format that organizes
assessment data systematically
 1. Maslow’s basic needs
2. Body System Model
3. Gordon’s Functional Health Patterns
Gordon’s Functional Health Patterns
1. Health perception – health management pattern
2. Nutritional pattern
3. Elimination pattern
4. Activity – rest pattern
5. Sleep – rest pattern
6. Cognitive – perceptual pattern
7. Self – perception – concept pattern
8. Role – reproductive pattern
9. Sexuality – reproductive pattern
10. Coping – stress tolerance pattern
11. Value – belief pattern
4. ANALYZE DATA
Compare data against standard and identify significant
cues. Standard /norm are generally accepted
measurements, model pattern
Example : normal vital signs, standard weight and height ,
normal laboratory values / diagnostics values , normal
growth and developmental patern
5. COMMUNICATIVE /RECORD /DOCUMENT
DATA
Nurse records all data collected about the client’s health
status
Data are recorded in a factual manner not as interpreted
by the nurse
Record subjective data in client's words; restating in other
words what client says might change its original meaning
DIAGNOSIS
It is the 2nd step of the nursing process .It is the process of
reasoning or the clinical act of identifying problems
PURPOSE :
1. To identify health care needs and prepare a Nursing
Diagnosis
2. To diagnose in nursing
3. It means to analyze assessment information and derive
meaning from this analysis
Nursing Diagnosis
1. It a statement of a client’s potential or actual health
problem resulting from analysis of data
2. Is a statement of client’s potential or actual alterations /
changes in his health status
3. A statement that describes a client actual or potential
health problems that a nurse can identify and for which
she can order nursing interventions to maintain the
health status , to reduce , eliminate or prevent alterations
/changes
Nursing Diagnosis
4. Is the problem statement that the nurse makes regarding
a client’s condition which she uses to communicate
professionally
5. It uses the critical thinking skills analysis and synthesis
in order to identify client’s strengths & health problems
that can be resolved /prevented by collaborative and
independent nursing interventions
6. Analysis – separation into components or the breaking
down of the whole into its parts
[Link] – the putting together of parts into whole
ACTIVITIES OF NURSING DIAGNOSIS
Three activities in Diagnosing :
1. Data Analysis
2. Problem Identification
3. Formulation of Nursing Diagnosis
Characteristics of Nursing Diagnosis
4. It states a clear and concise health problem
5. It is derived from existing evidences about the client
6. It is potentially amenable to nursing therapy
7. It is the basis for planning and carrying out nursing care
Components of A nursing diagnosis
Problem statement /diagnosis label/definition =P
Etiology /related factors /causes =E
Defining characteristics /signs and symptoms =E
Therefore may be written as a 2 –part or a 3 – part
statement
Types of Nursing Diagnosis
1. Actual Nursing Diagnosis : a client problem that is
present at the time of the nursing assessment .It is based
on the presence of signs and symptoms
Example :
a. Imbalanced nutrition : Less than body requirements r/t
decreased appetite , nausea
b. Disturbed sleep pattern r/t cough , fever and pain
c. Constipation r/t long term use of laxative
d. Ineffective airway clearence r/t to viscous secretion
Noncomplaince (Medication) r /t unknown etiology
Noncomplaince (diabetic diet ) r/t unresolved anger about
diagnosis
Acute pain (chest) r/t cough secondary to pneumonia
Activity intolerance r/t general weakness
Anxiety r/t difficulty of breathing and concerns over work
[Link] nursing diagnosis : one in which evidence
about a health problem is incomplete or unclear therefore
requires more data so support or reject it ; or the causative
factors are unknown but a problem is only considered
possible to occur
Example :
a. Possible nutritional deficit
b. Possible low esteem r/t processes r/t unfamiliar
conditions
3. Risk nursing diagnosis : it is a clinical judgment that
a problem does not exist , therefore no S/S are present ,
but the presence of RISK FACTORS indicates that a
problem is on likely to develop unless nurse intervenes or
do something about it . No subjective or objective cues
are present therefore the factors that cause the client to be
more vulnerable to the problem are the etiology of a risk
nursing diagnosis
Example : 1. risk for impaired skin integrity (left ankle) r/t
decrease peripheral circulation in diabetes
2. Risk for infection r/t compromised immune system
THANK YOU